Clinical Intake Form

Clinical Intake Form Template for England and Wales

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Key Requirements PROMPT example:

I need a Clinical Intake Form for my new private psychology practice opening in March 2025, focusing on adult mental health services and including specific sections for anxiety and depression screening.

What is a Clinical Intake Form?

The Clinical Intake Form serves as the primary document for gathering patient information when they first engage with a healthcare service in England and Wales. This document is essential for establishing a medical record that complies with UK healthcare regulations and data protection laws. It typically includes sections for personal information, medical history, current medications, allergies, and informed consent. The form ensures healthcare providers collect consistent, comprehensive information while meeting their legal and professional obligations under UK law.

What sections should be included in a Clinical Intake Form?

1. Patient Demographics: Basic personal information including name, date of birth, NHS number, gender, address, contact details, preferred contact method

2. Emergency Contacts: Details of next of kin and emergency contacts including relationship, contact information and access permissions

3. Medical History: Current and past medical conditions, surgeries, medications, allergies, immunizations and family medical history

4. Consent Declaration: Patient's explicit consent for treatment, data processing, and information sharing in accordance with UK GDPR

5. Insurance Information: Details of medical insurance if applicable, including policy numbers and coverage details

What sections are optional to include in a Clinical Intake Form?

1. Mental Health Assessment: Detailed mental health history, current symptoms, and previous treatments - required for psychiatric or psychological services

2. Pain Assessment: Comprehensive pain evaluation including location, intensity, duration and triggers - used for pain management or chronic conditions

3. Substance Use History: Detailed history of alcohol, tobacco, or drug use, including current usage and treatment history - relevant for addiction or recovery programs

4. Disability Assessment: Evaluation of any disabilities and required accommodations - used when specific accessibility needs must be addressed

5. Cultural and Religious Considerations: Specific cultural or religious requirements that may affect treatment or care delivery

What schedules should be included in a Clinical Intake Form?

1. Privacy Notice: Detailed information about how patient data will be used, protected, and shared in compliance with UK GDPR and Data Protection Act 2018

2. Patient Rights and Responsibilities: Comprehensive document outlining patient's rights, responsibilities, and complaint procedures

3. Medical Records Release Authorization: Standard form for authorizing release of medical information to specified third parties

4. Capacity Assessment Form: Template for recording mental capacity assessments when required under Mental Capacity Act 2005

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Construction
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Healthcare

Relevant Teams

Engineering
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Quality Assurance
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Relevant Roles

Project Manager
Mechanical Engineer
Construction Manager
Quality Control Manager
Contract Administrator
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Industries

UK GDPR and Data Protection Act 2018: Primary legislation governing how personal and medical data must be collected, processed, and stored in the UK following Brexit. Key for ensuring compliant handling of patient information in clinical intake forms.

Health and Social Care Act 2008: Fundamental legislation establishing the regulatory framework for health and social care services in England and Wales, including requirements for clinical documentation and record-keeping.

Care Quality Commission Regulations 2009: Specific regulations detailing requirements for healthcare providers' registration and ongoing compliance, including standards for documentation and patient information collection.

Access to Health Records Act 1990: Legislation governing patients' rights to access their health records and the requirements for maintaining medical records, directly impacting how clinical information must be documented.

Medical Act 1983: Core legislation establishing the framework for medical practice regulation in the UK, including requirements for medical record-keeping and professional standards.

Mental Capacity Act 2005: Essential legislation for determining and documenting patient capacity to consent, crucial for clinical intake processes where capacity assessment may be necessary.

Equality Act 2010: Legislation ensuring non-discriminatory practices in healthcare provision and documentation, requiring inclusive and accessible clinical intake procedures.

Professional Standards Requirements: Guidelines from regulatory bodies like GMC and NMC that set specific standards for clinical documentation and patient information collection.

Common Law Duty of Confidentiality: Legal obligation to maintain patient confidentiality, fundamental to the design and implementation of clinical intake forms and information handling procedures.

NHS Constitution: Framework establishing patient rights and NHS responsibilities, influencing how clinical information should be collected and managed while respecting patient rights.

Human Rights Act 1998: Overarching legislation ensuring respect for human rights in healthcare contexts, including privacy and dignity in clinical documentation processes.

Find the exact document you need

Medical Intake Form

A standardized template for collecting patient information in England and Wales, compliant with UK healthcare and data protection regulations.

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Let's create your Clinical Intake Form

What is a Clinical Intake Form?

What sections should be included in a Clinical Intake Form?

What sections are optional to include in a Clinical Intake Form?

What schedules should be included in a Clinical Intake Form?

Authors

Alex Denne

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